Case study: Diamonds are forever?

How Pennine Acute Hospitals NHS Trust has deployed Diamond.NET to create a paperless diabetes service

In this article we look at how Pennine Acute Hospitals Trust is using innovative technology to improve diabetes outcomes and drive integrated care in North East Manchester

Diamond.NET allows us to be paper-less – meaning that we no longer have to carry patient notes around with us.

About the trust

The Pennine Acute Hospitals NHS Trust is the largest non-teaching trust in the country, serving a population of around 820,000 people in the North East sector of Greater Manchester. The trust, which employs around 8,000 staff, operates across four sites and has a total operating budget of more than half a billion pounds. Its main commissioners are NHS Bury, NHS Heywood, Middleton and Rochdale, NHS Oldham and NHS Manchester.

Historically, diabetes has been identified as one of the principal contributors to inequalities in mortality between Manchester residents and the rest of England. As such, the region has adopted a number of measures designed to drive standards of care, reduce the incidence and cost of complications, and improve health outcomes for diabetes patients. The local health economy has invested heavily in programmes to tackle childhood obesity and has also been at the forefront of a national initiative to implement personalised care plans for adult and paediatric diabetics.

In the past few years, the Pennine Acute Hospitals NHS Trust has also increased investment in technologies designed to support the delivery of integrated care across the region. In October 2013, it extended its partnership with Hicom, the leading provider of clinical management software solutions, with the introduction of Diamond.NET - a web-based adult and paediatric multi-disciplinary EPR system for patients with long-term conditions such as diabetes. The solution is already proving highly valuable, underpinning the trust’s strategy to improve integrated care pathways for diabetes patients and driving productivity and efficiency gains across its acute and community settings.

The challenge

The treatment of diabetes remains one of the NHS’s top priorities. Data consistently shows that the disease consumes as much as 10% of the NHS budget, with the cost of associated complications and related hospital admissions making it a hugely-expensive condition.

This real-time information is vital for optimal care and is really helping clinical teams ensure patients are managed appropriately and effectively

The management of long-term conditions such as diabetes sits at the heart of the NHS Outcomes Framework 2014/15. Long-standing goals to reduce avoidable hospital admissions and to shift diabetes care out of expensive acute settings and into the community have often been hamstrung by the NHS’s failure to implement the optimal technological infrastructure to support integrated care. However, progress is being made.

The most-progressive NHS trusts are deploying simple yet innovative web-based systems to join-up diabetes care pathways and provide real-time patient information for healthcare professionals at the point of clinical need.

Technology in diabetes management

Pennine Acute Hospitals NHS Trust’s use of technology to manage diabetes patients is not new; it first began using Hicom’s legacy system for adult diabetes, Diamond, in 2005. However, with the region’s renewed emphasis on childhood diabetes – as well as its commitment to provide joined-up and real-time information support for HCPs in mobile and community settings – the need for a more holistic and accessible solution had become critical.

“The legacy Diamond system had run successfully in North Manchester since 2005, and across the trust since 2006, with medical staff recognising – and indeed embracing – the benefits of electronic patient records and the ability to report activities quickly and easily,” said Stephanie Tarpey, clinical systems team manager for IM&T at Pennine Acute Hospitals NHS Trust.

“But the move to Diamond.NET has significantly increased accessibility to the system. It not only incorporates adult and paediatric diabetes, but it means that anyone involved in diabetes care can now benefit from real-time patient information. We currently have around 210 people using the system, including podiatry, dieticians, diabetes specialist nurses (DSNs), antenatal clinics and community teams.”

The system is proving hugely beneficial – helping to drive significant clerical and communications efficiencies, as well as empowering healthcare professionals with critical patient information and accelerating care pathways.

“Diamond.NET is helping us to become much more efficient operationally – and brings real economies of scale,” said Tarpey.

This is reducing manual admin work, accelerating clinical correspondence and improving the accuracy of communications

“We are now able to create our own letter templates – pulling together information from any of our hospital sites, outlying clinics or community services, and then feeding it into our automated letter system. This is reducing manual admin work, accelerating clinical correspondence and improving the accuracy of communications.

“Alongside this, healthcare professionals can – irrespective of their setting – access real-time patient information quickly and painlessly. For example, a doctor on a medical ward can immediately see if a patient has recently spoken to a dietician or a DSN or can learn which insulins a patient is using. This real-time information is vital for optimal care and is really helping clinical teams ensure patients are managed appropriately and effectively.”

The multiplicity of settings associated with diabetes care has historically provided challenges for NHS trusts in their efforts to deliver integrated services. But Diamond.NET is helping Pennine Acute Hospital Trust to overcome this.

“The complex nature of diabetes means that it’s common to have different healthcare professionals seeing patients at different sites,” said Dr Biswa Mishra, associate clinical director of diabetes and endocrinology at the trust.

“Diamond.NET is a very effective medium for us to communicate through, without the need for letter writing – which has obvious problems in terms of the time it takes and the availability of notes. Even if someone has been seen by one healthcare professional in the morning, and then is with another in the afternoon, the latter is able to access that information very easily through Diamond.NET.

“Moreover, with our integration of services between the specialist and community diabetes services, we provide care from a wide variety of locations outside of hospital. Diamond.NET allows us to be paper-less – meaning that we no longer have to carry patient notes around with us. With the system in place, we still have access to all the information we need to make clinical decisions.”

The Diamond.NET system is also helping the trust meet its audit requirements. The solution, which integrates seamlessly with the hospital’s PAS system, ensuring it is powered by timely and accurate patient demographic data, collates, aggregates and reports information that is commonly required for national audit.

“Fulfilling the requirements for the National Diabetes Audit and the National Paediatric Diabetes Audit can be an onerous process, but Diamond.NET helps enormously. We can easily pull specific data from the system and submit it for audit. If we had to do it manually, it would take a huge amount of time,” said Tarpey.

“And beyond audit requirements, we can also conduct ad hoc research quickly and comprehensively - enabling us to benchmark performance and quantify progress against the Best Practice Tariff.”

Dr Mishra added: “It’s important to show our commissioners that the things they are contracting us to do are being carried out effectively. Diamond.NET enables us to provide that proof – and it’s so much easier to extract data if you have captured it electronically, rather than in a paper-based system.”

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